Torsional ultrasound mode versus combined torsional and conventional ultrasound mode phacoemulsification for eyes with hard cataract

Abstract

Purpose:To compare torsional versus combined torsional and conventional ultrasound modes in hard cataract surgery regarding ultrasound energy and time and effect on corneal endothelium. Settings: Kasr El Aini hospital, Cairo University, and International Eye Hospital, Cairo, Egypt. Methodology: Ninety-eight eyes of 63 patients were enrolled in this prospective comparative randomized masked clinical study. All eyes had nuclear cataracts of grades III and IV using the Lens Opacities Classification System III (LOCS III). Two groups were included, each having an equal number of eyes (49). The treatment for group A was combined torsional and conventional US mode phacoemulsification, and for group B torsional US mode phacoemulsification only. Pre-and post-operative assessments included best corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp evaluation, and fundoscopic evaluation. Endothelial cell density (ECD) and central corneal thickness (CCT) were measured preoperatively, 1 day, 7 days, and 1 month postoperatively. All eyes were operated on using the Alcon Infiniti System (Alcon, Fort Worth, TX) with the quick chop technique. All eyes were implanted with AcrySof SA60AT (Alcon) intraocular lens (IOL). The main phaco outcome parameters included the mean ultrasound time (UST), the mean cumulative dissipated energy (CDE), and the percent of average torsional amplitude in position 3 (%TUSiP3). Results: Improvement in BCVA was statistically significant in both groups (P , 0.001). Comparing UST and CDE for both groups revealed results favoring the pure torsional group (P = 0.002 and P , 0.001 for UST; P = 0.058 and P = 0.009 for CDE). As for %TUSiP3, readings were higher for the pure torsional group (P = 0.03 and P = 0.01). All changes of CCT, and ECD over time were found statistically significant using one-way ANOVA testing (P , 0.001). Conclusion: Both modes are safe in hard cataract surgery, however the pure torsional mode showed less US energy used.

Combined 30-degree bevel up and down technique against 0-degree phaco tip for phacoemulsification surgery of hard cataracts

“…High CDE reading is equated with statistically significant corneal endothelial cell loss with one surgeon, one technique and one setting 17,18. Fakhry and El Shazly have shown that with an increase in the density of the nuclei there is an increase in the CDE 19. CDE in our study was less than the longitudinal and the torsional modality in the study by Fakhry and El Shazly.…”

Comparative analysis of corneal morphological changes after transversal and torsional phacoemulsification through 2.2 mm corneal incision

“…Torsional and transversal phaco modes are the results of these technological advances. Several studies have confirmed and reported the superiority of torsional phaco over longitudinal phaco in terms of needle time, chatter, followability, corneal edema, and corneal endothelium 1,5,7–12,19,20. However, to date, only one study has compared longitudinal, torsional, and transversal phaco 5.…”

Comparison of Cornea Endothelial Cells Density the After Aspiration of Dense Cataracts using Two Variants of Phacoemulsification Parameters

“…Особенно высок риск осложнений при удалении плотного хрусталика [4]. В этом случае большое значение имеют не только мануальные навыки хирурга, но и гидродинамические и ультразвуковые настройки прибора, которые должны строго соответствовать особенностям хирургического подхода, используемого конкретным хирургом [5][6][7][8]. Соответствие настроек тем манипуляциям, которые присущи врачу, обеспечивает безопасность и эффективность процедуры.…”

“…При неправильно подобранных настройках существенно возрастает риск травматизации окружающих тканей: радужки, цилиарного тела, капсульного мешка и роговицы [4,9,10]. Если повреждение радужки или капсульного мешка чаще приводит к серьезным интраоперационным осложнениям, то травма эндотелия роговицы чревата декомпенсацией состояния роговицы в послеоперационном периоде [1][2][3][4][5][6][7][8][9][10][11][12][13]. Послеоперационная кератопатия чаще всего связана с избыточной травмой эндотелия в ходе операции [13,14].…”